It's bargaining time over health reform

WASHINGTON -- When two moderate senators recently became the first Democrats to publicly reject the Clinton health care reform plan in favor of a less ambitious Republican alternative, the Democratic chairman of the Senate Finance Committee was delighted.

In fact, Chairman Daniel Patrick Moynihan, the brainy and blunt New Yorker who has been struggling to build a consensus around the Clinton bill, had encouraged Sen. David L. Boren of Oklahoma to join Sen. Bob Kerrey of Nebraska in their defection.

Mr. Moynihan was hoping, according to senators familiar with his thinking, that the White House would get the message that it's time to bargain in earnest -- with Republicans as well as Democrats -- if sweeping health care reform is to become law this year.

Congressional debate over health care reform is entering a critical phase this month amid signs that most lawmakers are unwilling to move as far or as fast as President Clinton to overhaul one-seventh of the national economy. The three major committees that are working toward Memorial Day deadlines for endorsing some version of the bill are mired in disputes over a political hot potato: how to pay for it all.

The lawmakers are weighing such politically unattractive options as requiring employers to pay most health care costs, imposing new broad-based taxes and eliminating tax deductions for employer-paid health benefits. They are finding little enthusiasm.

"Remarkably, here we are in May, and we're still left with the question of how we're going to pay for this whole thing," Mr. Kerrey said. "At some point, we've got to move."

Mr. Clinton got one bit of seemingly good news yesterday from Sen. Edward M. Kennedy, the Massachusetts Democrat who chairs the Labor and Human Resources Committee. Mr. Kennedy unveiled a health care proposal much like the president's that the senator's committee will take up next week.

Yet the Kennedy bill has almost no chance of being endorsed by the full Senate, where Republicans and conservative Democrats hold the balance of power -- as they do in the Finance Committee. Mr. Kennedy's committee, by contrast, is made up mostly of liberal Democrats.

The stalemate is neither unusual nor necessarily fatal to the legislation. Lawmakers tend to leave unpleasant tasks to the last minute. As a practical matter, they have until October to finish work on the bill.

Who pays?

But the 1,300-page health-care reform measure submitted by Mr. Clinton in September is the most complex and comprehensive legislation in decades. It would affect every American. And almost none of the decisions about what would be covered and who would be eligible can be resolved until Congress decides who pays and how much.

"It's time to get something down on paper," said Sen. John B. Breaux of Louisiana, a Finance Committee member who was one of the first Democrats to adopt a bipartisan approach to health reform. The longer we wait, the easier it will be to defeat."

Committee leaders have been trying mightily to get something down on paper.

Rep. John D. Dingell, a Michigan Democrat who chairs the House Energy and Commerce Committee, has drafted two substitutes to the origi- nal Clinton plan. Those plans would relieve nearly all the burden on small businesses, which are among the Clinton bill's most vocal opponents. Mr. Dingell proposes that companies with more than 10 employees pay 80 percent of workers' premiums and a payroll tax to help subsidize premiums for all others. The president would apply the 80 percent requirement to all employers.

Yet Mr. Dingell is still one vote short of the 23 he needs to get a bill through his committee. And he can't get anyone else to budge.

"Congress is in love with delay," said Mr. Dingell, who has suspended work on the measure until he finds a working majority.

Rep. Dan Rostenkowski, the Illinois Democrat who is chairman of the House Ways and Means Committee, has enough votes to win approval for Mr. Clinton's proposal to impose the 80 percent requirement on employers. But he's stuck on how to find the rest of the money needed to subsidize low-income people and unemployed or part-time workers.

His committee is certain to approve a cigarette-tax increase of as much as $1.25 a pack. But Mr. Rostenkowski believes that much more will be needed.

'Tens of millions' needed

"Providing universal coverage will be expensive," he said last month. "We'll need a substantial amount of new revenue -- tens of millions of dollars a year -- when the new programs are fully in place. That means broad tax increase may be required and that everyone may have to make a tangible contribution to finance this program."

But Ways and Means Committee members, such as Rep. Benjamin L. Cardin, a Baltimore Democrat, are trying to steer Mr. Rostenkowski away from the notion of a broad-based tax, toward a combination of much smaller levies, such as a tax on insurance premiums. Mr. Rostenkowski is expected soon to begin bargaining with each Democratic committee member individually.